Metformin Underused in Diabetes Due to Kidney Concerns

The contraindication to metformin use in patients with renal insufficiency may be impeding care to thousands of diabetes patients in the U.S.
The contraindication to metformin use in patients with renal insufficiency may be impeding care to thousands of diabetes patients in the U.S.

(HealthDay News) -- Concerns about safety of metformin in renal impairment may be unnecessarily preventing its use in type 2 diabetes mellitus (T2DM), according to a research letter published online Jan. 5 in JAMA Internal Medicine.

Noting that metformin carries a contraindication against use when serum creatinine levels are in excess of 1.4 mg/dL in women or 1.5 mg/dL in men, James H. Flory, M.D., from the Weill Cornell Medical College in New York City, and Sean Hennessy, Pharm.D., Ph.D., from the University of Pennsylvania in Philadelphia, examined the public health importance of this issue. The authors used 2006 to 2012 data from the National Health and Nutrition Examination Survey to examine how much metformin nonuse is due to safety concerns in renal insufficiency.

The researchers found that the rates of metformin use were 90.4 percent in patients with an estimated glomerular filtration rate (eGFR) exceeding 90 mL/min, 80.6 percent at >60 to 90 mL/min, 48.6 to 57.4 percent at 30 to 60 mL/min, and 17.9 percent at <30 mL/min. If 90.4 percent use rates were also seen for patients with eGFR of >60 to 90 mL/min or eGFR of 30 mL/min, there would be an increase of about 425,000 and 560,000 patients, respectively, taking metformin.

"The FDA is overdue to revisit the contraindication to metformin use in patients with renal insufficiency, which may be worsening the care of almost one million patients with T2DM in the United States," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

Source

  1. James H. Flory, J, et al. JAMA Intern Med, published online January 05, 2015. doi:10.1001/jamainternmed.2014.6936.
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